Disseminated Blastomycosis in an African American immunocompetent pediatric patient: Lessons learned.

Disseminated blastomycosis can be challenging to diagnose given possible involvement of nearly any extrapulmonary organ system and the limitations of fungal diagnostic testing. Certain racial groups are at increased risk of disseminated fungal infections, even in immunocompetent patients. We describe a case of disseminated blastomycosis with cutaneous involvement in an African American adolescent with delayed diagnosis. Dermatologists can play an important role in the timely diagnosis of this disease entity by performing appropriate cutaneous biopsy techniques and should be involved early in these cases.

Alopecia in children undergoing chemotherapy, radiation, and hematopoietic stem cell transplantation: Scoping review and approach to management.

Alopecia is a common sequela in children undergoing chemotherapy, radiation, and hematopoietic stem cell transplantation. In most cases, this is a transient state in which full hair regrowth eventually occurs, but permanent or persistent alopecia, defined as the presence of incomplete hair regrowth more than 6 months after cessation of treatment, is possible and can be psychologically distressing. We sought to characterize the risk factors that can lead to permanent alopecia following the aforementioned treatments in pediatric populations, as well as diagnostic and treatment options that may be considered, as part of a scoping review of the literature. A general algorithm for approaching these patients was developed based on our findings.

Intravenous Ketamine Infusion as an Adjunctive Pain Treatment for Erythromelalgia: A Pediatric Case Report.

Erythromelalgia is a rare neurovascular pain condition characterized by erythematous, warm, and painful extremities. Symptoms are exacerbated by heat and relieved by cooling. Treatment is challenging and focuses on symptom control with various medications and therapies targeted toward eliminating destructive cooling behaviors. This pediatric case was notable because the patient's pain dramatically improved after a short-term, low-dose ketamine infusion, allowing her to finally wean off detrimental cooling practices of her extremities. Intravenous ketamine has rarely been described as an adjunctive analgesic strategy for erythromelalgia.

Comparación de dos técnicas intervencionistas para el tratamiento del dolor crónico de hombro / Comparison of two interventional techniques for the treatment of chronic shoulder pain

Abstract Introduction: The prevalence of chronic shoulder pain is 20%, and treatment involves pharmacological and non-pharmacological means, as well as analgesic interventional procedures. The use of intra-articular injections and ultrasound-guided blocks has increased with favorable results, but there are few comparisons to determine their effective use in patients with chronic pain due to shoulder arthrosis refractory to pharmacological treatment. Objective: To compare the clinical efficacy and safety of 2 interventional techniques in patients with chronic shoulder pain secondary to arthrosis. Methods: Retrospective cohort analytical study to compare the clinical efficacy and safety of 2 interventional techniques in terms of pain relief, improvement time, and adverse effects in patients coming to Instituto Colombiano del Dolor (Colombian Pain Institute) between June 2011 and April 2012, followed during a period of at least 16 weeks. Results: The analysis included 62 patients with chronic shoulder pain secondary to osteoarthritis. Suprascapular nerve blocks were performed in 29 patients, and tricompartmental blockade was used in 33 patients, and both procedures were performed under ultrasound guidance. A statistically significant reduction in pain intensity was found during the 16-week period in both groups (P < 0.0001), and there were no complications. Conclusion: Both analgesic techniques provided significant pain reduction over the 16-week period, with a superior clinical trend in favor of the suprascapular nerve block, and they were found to be safe therapeutic options because of the low rate of complications.

Resumen Introducción: La prevalencia del dolor crónico de hombro es del 20%; su tratamiento incluye medidas farmacológicas, no farmacológicas e intervencionismo analgésico. Recientemente se ha aumentado la práctica de inyecciones intrarticulares y bloqueos periféricos guiados por ultrasonido con resultados favorables pero con pocas comparaciones que permitan determinar su utilidad en pacientes con dolor crónico por artrosis de hombro que no mejoran con tratamiento farmacológico. Objetivo: Comparar la eficacia clínica y la seguridad de dos técnicas intervencionistas en pacientes con dolor crónico de hombro secundario a artrosis. Métodos: Estudio analítico de cohorte retrospectiva para comparar la eficacia clínica y seguridad de dos técnicas intervencionistas, en términos de disminución del dolor, tiempo de mejoría y efectos adversos, en pacientes que consultaron al Instituto Colombiano del Dolor entre junio de 2011 y abril de 2012 y que fueron seguidos por al menos 16 semanas. Resultados: se analizaron 62 pacientes con dolor crónico de hombro secundario a osteoartritis. A 29 pacientes se les realizó un bloqueo de nervio supraescapular y a 33 un bloqueo tricompartimental de hombro, ambos guiados por ultrasonografía. Se encontró una disminución estadísticamente significativa de la intensidad del dolor a lo largo de las 16 semanas en ambos grupos (p<0,0001), con ausencia de complicaciones. Conclusión: Ambas técnicas analgésicas proveen una disminución significativa del dolor en las 16 semanas, con una tendencia clínica superior en favor del bloqueo supraescapular, y representan una opción terapéutica segura por la baja presentación de complicaciones.

Multilocus microsatellite typing of Leishmania infantum isolates in monitored Leishmania/HIV coinfected patients.

BACKGROUND: Leishmania infantum is the main etiological agent of both visceral and cutaneous clinical forms of leishmaniasis in the Mediterranean area. Leishmania/HIV coinfection in this area is characterized by a chronic course and frequent recurrences of clinical episodes. The present study using Multilocus Microsatellite Typing (MLMT) analysis, a highly discriminative tool, aimed to genetically characterize L. infantum isolates taken from monitored Leishmania/HIV coinfected patients presenting successive clinical episodes. METHODS: In this study, by the analysis of 20 microsatellite loci, we studied the MLMT profiles of 25 L. infantum isolates from 8 Leishmania/HIV coinfected patients who had experienced several clinical episodes. Two to seven isolates per patient were taken before and after treatment, during clinical and non-clinical episodes, with time intervals of 6 days to 29 months. Genetic diversity, clustering and phenetic analyses were performed. RESULTS: MLMT enabled us to study the genetic characteristics of the 25 L. infantum isolates, differentiating 18 genotypes, corresponding to a genotypic diversity of 0.72. Fifteen genotypes were unique in the total sample set and only 3 were repeated, 2 of which were detected in different patients. Both clustering and phylogenetic analyses provided insights into the genetic links between the isolates; in five patients isolates showed clear genetic links: either the genotype was exactly the same or only slightly different. In contrast, the isolates of the other three patients were dispersed in different clusters and some could be the result of mixing between populations. CONCLUSIONS: Our data indicated a great MLMT variability between isolates from coinfected patients and no predominant genotype was observed. Despite this, almost all clinical episodes could be interpreted as a relapse rather than a reinfection. The results showed that diverse factors like an intrapatient evolution over time or culture bias could influence the parasite population detected in the patient, making it difficult to differentiate between relapse and reinfection.

[Effect of zinc amino acid chelate and zinc sulfate in the incidence of respiratory infection and diarrhea among preschool children in child daycare centers]. / Efecto del zinc aminoquelado y el sulfato de zinc en la incidencia de la infección respiratoria y la diarrea en niños preescolares de centros infantiles.

INTRODUCTION: Zinc deficiency is common in children among populations in developing areas. Zinc deficiency alters the immune system and the resistance to infections. OBJECTIVE: To evaluate the effect of two zinc compounds in the prevention of acute respiratory infection and acute diarrhea. MATERIALS AND METHODS: Randomized triple-blind community trial with 301 children between 2-5 years of age from six child daycare centers in Medellin, Colombia. Children were distributed in three groups receiving zinc amino acid chelate, zinc sulfate and placebo five days a week for 16 weeks. Daily symptoms of respiratory infection, acute diarrhea and side effects were evaluated. RESULTS: The incidence of respiratory infection was lower with zinc amino acid chelate (1.42 per 1,000 child-days) compared with placebo (3.3 per 1,000 child-days) (RR=0.43, 95% CI: 0.196 to 0.950, p=0.049) and with zinc sulfate (1.57 per 1,000 child-days) (RR=0.90, 95% CI 0.382 to 2.153, p=0.999). The incidence of acute diarrhea with zinc amino acid chelate (0.15 per 1,000 child-days) was lower than with placebo (0.49 per 1,000 child-days) (RR=0.32, 95% CI 0.006 to 3.990, p=0.346) and with zinc sulfate (0.78 per 1,000 child-days) (RR=0.20, 95% CI: 0.0043 to 1.662, p=0.361). CONCLUSIONS: Zinc amino acid chelate had a better effect in reducing the incidence of acute respiratory infection and acute diarrhea in preschool children when compared with the other groups.

Efecto del zinc aminoquelado y el sulfato de zinc en la incidencia de la infección respiratoria y la diarrea en niños preescolares de centros infantiles / Effect of zinc amino acid chelate and zinc sulfate in the incidence of respiratory infection and diarrhea among preschool children in child daycare centers

Introducción. El déficit de zinc es común en niños de poblaciones en desarrollo. La deficiencia de zinc altera el sistema inmunológico y la resistencia a las infecciones. Objetivo. Evaluar el efecto de dos compuestos de zinc en la prevención de la infección respiratoria y la diarrea agudas. Materiales y métodos. Se llevó a cabo un ensayo comunitario triple ciego en 301 niños entre dos y cinco años de edad de centros infantiles de Medellín. Fueron seis conglomerados distribuidos aleatoriamente en tres grupos de intervención que recibieron zinc aminoquelado, sulfato de zinc y placebo durante cinco días de la semana a lo largo de 16 semanas. Se evaluaron diariamente los síntomas de infección respiratoria, diarrea aguda y efectos secundarios. Resultados. La incidencia de la infección respiratoria fue menor con el zinc aminoquelado (1,42 por 1.000 días-niño) comparado con el sulfato de zinc (1,57 por 1.000 días-niño) (RR=0,90, IC 95% : 0,382 a 2,153 , p=0,999) y con el placebo (3,3 por 1.000 días-niño) ( RR=0,43, IC 95% : 0,196 a 0,950 , p=0,049). La incidencia de diarrea aguda con el zinc aminoquelado (0,15 por 1.000 días-niño) fue menor que con el sulfato de zinc (1,18 0,78 por 1.000 días-niño) (RR=0,20, IC 95% : 0,0043 a 1,662, p=0,361) y que la del grupo placebo (0,49 por 1.000 días-niño) (RR=0,32, IC 95% : 0,006 a 3,990 , p=0,346). Conclusiones. El zinc aminoquelado tuvo mejor efecto en la disminución de la incidencia de la infección respiratoria y la diarrea agudas en niños preescolares comparado con los otros grupos de estudio.

Introduction: Zinc deficiency is common in children among populations in developing areas. Zinc deficiency alters the immune system and the resistance to infections. Objective: To evaluate the effect of two zinc compounds in the prevention of acute respiratory infection and acute diarrhea. Materials and methods: Randomized triple-blind community trial with 301 children between 2-5 years of age from six child daycare centers in Medellin, Colombia. Children were distributed in three groups receiving zinc amino acid chelate, zinc sulfate and placebo five days a week for 16 weeks. Daily symptoms of respiratory infection, acute diarrhea and side effects were evaluated. Results: The incidence of respiratory infection was lower with zinc amino acid chelate (1.42 per 1,000 child-days) compared with placebo (3.3 per 1,000 child-days) (RR=0.43, 95% CI: 0.196 to 0.950, p=0.049) and with zinc sulfate (1.57 per 1,000 child-days) (RR=0.90, 95% CI 0.382 to 2.153, p=0.999). The incidence of acute diarrhea with zinc amino acid chelate (0.15 per 1,000 child-days) was lower than with placebo (0.49 per 1,000 child-days) (RR=0.32, 95% CI 0.006 to 3.990, p=0.346) and with zinc sulfate (0.78 per 1,000 child-days) (RR=0.20, 95% CI: 0.0043 to 1.662, p=0.361). Conclusions: Zinc amino acid chelate had a better effect in reducing the incidence of acute respiratory infection and acute diarrhea in preschool children when compared with the other groups.

Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011 / Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011

Introducción. La disminución de los depósitos de hierro constituye el primer eslabón de la cadena conducente a la deficiencia de hierro, la carencia nutricional más prevalente y principal causa de anemia en todo el mundo, situación que puede prevenirse mediante la fortificación de alimentos. Objetivo. Comparar la eficacia del hierro aminoquelado con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro. Materiales y métodos. Se llevó a cabo un ensayo clínico triple ciego con distribución aleatoria de grupos. Se analizaron 56 preescolares con deficiencia de hierro (ferritina menor de 24 ng/ml) a los que se les dio diariamente 13 g de leche con 12,5 mg de hierro,. Después de dos meses se midieron los niveles de hemoglobina, hematocrito y ferritina sérica. Resultados. En el grupo con sulfato ferroso la concentración de ferritina sérica aumentó de 18,8 a 24,1 ng/ml, mientras que dicha variación fue de 18,4 a 29,7 ng/ml con el hierro aminoquelado, en ambos casos con diferencias significativas. El nivel de ferritina final difirió según el grupo de estudio, siendo mayor en el grupo con hierro aminoquelado (p=0,022). La hemoglobina y el hematocrito no variaron después de la intervención. Las reacciones adversas en el grupo con sulfato ferroso fueron de 35,7 %, en contraste con el 42,9 % en el grupo con hierro aminoquelado; cinco niños presentaron infección de las vías respiratorias, sin diferencias estadísticas. Conclusiones. Los dos compuestos aumentan los niveles de ferritina, siendo mayor el aumento entre quienes toman leche con hierro aminoquelado. No fue diferente la incidencia de reacciones adversas o de infecciones entre los grupos.

Introduction: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. Objective: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. Materials and methods: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. Results: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. Conclusions: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

[Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011]. / Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011.

INTRODUCTION: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. OBJECTIVE: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. MATERIALS AND METHODS: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. RESULTS: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. CONCLUSIONS: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

VIH en habitantes de calle de Medellín / HIV among the street dwellers of Medellín

OBJETIVO: determinar la prevalencia de VIH y las características socio-demográficas del habitante de calle en la ciudad de Medellín, con la finalidad de ampliar la comprensión de la problemática en este grupo vulnerable. METODOLOGÍA: se realizó un estudio de corte transversal; se determinó la seroprevalencia de VIH y los comportamientos de riesgo. El procesamiento se realizó mediante el software SPSS 8.0. El análisis bivariado se acompañó con pruebas estadísticas. RESULTADOS: se encuestaron 230 habitantes de calle,de los cuales el 69,6% eran hombres, con promedio de edad de 38 ± 10,9 años; se identificó una prevalencia de VIH del 7,8%; entre los hombres esta prevalencia fue de 10% y entre las mujeres fue de 2,9%. Por grupos de edad, el 12% de las personas de 25 a 34 años tenían VIH, el 11% de los mayores de 55 años y el 8% de las personas de 18 a 24 años. El 41% de los hombres y el 30% de las mujeres tenían creencias correctas sobre la transmisión del VIH. DISCUSIÓN: la prevalencia del 7,8% muestra que la infección por VIH en Colombia está concentrada en poblaciones que se encuentran en condiciones de exclusión, estigma y discriminación, y que se requieren acciones focalizadas hacia grupos vulnerables.

OBJECTIVE: to determine the prevalence of HIV among the street dwellers of the city of Medellin (Colombia) as well as their socio-demographic characteristics in order to deepen the understanding of the problems faced by this vulnerable group. METHODOLOGY: a cross-sectional study was conducted in which HIV seroprevalence and risk behaviors were determined. Data was processed using the SPSS 8.0 software, and the bivariate analysis was conducted using statistical methods. RESULTS: a survey was conducted on 230 street dwellers, 69.6% of which were men. The average age was 38 ± 10.9 years, and HIV prevalence was 7.8%. This prevalence was 10% for men and 2.9% for women. The rate of infected individuals was 12% for those aged 25 to 34, 11% for individuals aged 55, and 8% for those aged 18 to 24. Additionally, 41% of men and 30% of women had correct beliefs regarding HIV transmission. DISCUSSION: the prevalence value of 7.8%, shows that HIV infections in Colombia are concentrated in populations in a state of exclusion, stigma, and discrimination. This value also shows a need for actions targeting vulnerable groups.

[Risk of pathological gambling, Associated factors and mental disorders in youth from Medellin - Colombia]. / Riesgo de Juego Patológico. Factores y trastornos mentales asociados en jóvenes de Medellín - Colombia.

AIMS: To study the risk of pathological gambling and its possible relation with mental disorders and school and family problems in a population of school pupils from the city of Medellin (Colombia), with a view to providing guidance for mental health care. METHOD: Cross-sectional study; sample comprises 3486 students aged 10 to 19 years selected from all the educational institutions in the city. The sample is probabilistic and represents an estimated population of 290,000 young people from Medellin. The SOGS instrument (South Oaks Gambling Screening) was used for screening risk and likelihood of problem gambling. The analytic stage assessed possible associated factors such as mental disorders, alcohol use and drug use, with statistical significance levels of 5% and prevalence rates with 95% confidence intervals. RESULTS: A total of 48.6% were without problems, 37.6% were at risk and 13.8% were possible pathological gamblers. Males were more at risk than females (2.5:1), and the highest proportion of possible pathological gamblers was in the 10-14 age group (58.7%), vs. the 15-19 group (41.3%). Pathological gambling in young people is associated in this study with: anxiety OR=2.1(1.69-2.60), depression OR=1.73(1.33-2.24), suicide attempt OR=1.85(1.20-2.85), impulsivity OR=3.48(2.85-4.26), violent behavior OR=4.64(3.57-5.58), and problems at school OR=2.46(1.97-3.06); recent use of cigarettes, drunkenness and illegal drugs (use/addiction) were identified as associated risk factors, p value: <0.05. CONCLUSIONS: Pathological gambling risk is high in this young population, and is associated with mental disorders, use of psychoactive substances, and school and family problems. This situation suggests the need for large-scale and comprehensive preventive and therapeutic intervention measures for addressing the problem.

Riesgo de Juego Patológico. Factores y trastornos mentales asociados en jóvenes de Medellín - Colombia / Risk of Pathological Gambling, Associated factors and mental disorders in youth from Medellin - Colombia

Objetivos: Investigar el riesgo de juego patológico y su posible relación con trastornos mentales, problemas escolares y familiares, en una población escolarizada de la ciudad de Medellín (Colombia), para orientar la atención en salud mental. Método: Estudio de corte transversal; muestra de 3.486 estudiantes de 10 a 19 años, probabilística y representativa de una población de 290.000 jóvenes. El instrumento SOGS (South Oaks Gambling Screening), fue utilizado para evaluar el riesgo y probabilidad de juego patológico; en etapa analítica se evaluó la posible asociación con trastornos mentales, uso de alcohol y drogas para juego patológico, descritas con significancia estadística de 5% y proporciones de prevalencia con intervalos de confianza del 95%.Resultados: 48,6% sin problemas, 37,6% están en riesgo y 13,8% son posibles jugadores patológicos. Hombres tienen mayor riesgo que las mujeres (2,5:1) y la mayor proporción de posibles jugadores patológicos pertenecen al grupo de 10-14 años (58,7%) vs. 15-19 (41,3%). El Juego Patológico presenta asociación con ansiedad RD=2,1(1,69-2,60), depresión RD=1,73(1,33-2,24), intento de suicidio RD=1,85(1,20-2,85), impulsividad RD=3,48(2,85-4,26), comportamiento violento RD=4,64(3,57-5,58), problemas en la escuela RD=2,46(1,97-3,06); el uso de cigarrillo, alcohol hasta la embriaguez y el uso-adicción a drogas ilegales, se identificaron como factores asociados con valores de p<0,05. Conclusiones: La prevalencia de riesgo de juego patológico es alta para esta población y está asociada con trastornos mentales, consumo de sustancias psicoactivas y problemas en la relación familiar y escolar; esta situación señala la necesidad de generar un despliegue amplio e integral de intervención preventiva y terapéutica para impactar el problema (AU)

Aims: To study the risk of pathological gambling and its possible relation with mental disorders and school and family problems in a population of school pupils from the city of Medellin (Colombia), with a view to providing guidance for mental health care. Method: Cross-sectional study; sample comprises 3486 students aged 10to 19 years selected from all the educational institutions in the city. The sample is probabilistic and represents an estimated population of 290,000young people from Medellin. The SOGS instrument (South Oaks Gambling Screening) was used for screening risk and likelihood of problem gambling. The analytic stage assessed possible associated factors such as mental disorders, alcohol use and drug use, with statistical significance levels of 5% and prevalence rates with 95% confidence intervals. Results: A total of 48.6% were without problems, 37.6% were at risk and 13.8% were possible pathological gamblers. Males were more at risk than females (2.5:1), and the highest proportion of possible pathological gamblers was in the 10-14 age group (58.7%), vs. the 15-19 group (41.3%).Pathological gambling in young people is associated in this study with: anxiety OR=2.1(1.69-2.60), depression OR=1.73(1.33-2.24), suicide attempt OR=1.85(1.20-2.85), impulsivity OR=3.48(2.85-4.26), violent behavior OR=4.64(3.57-5.58), and problems at school OR=2.46(1.97-3.06); recent use of cigarettes, drunkenness and illegal drugs (use/addiction) were identified as associated risk factors, p value: <0.05. Conclusions: Pathological gambling risk is high in this young population, and is associated with mental disorders, use of psychoactive substances, and school and family problems. This situation suggests the need for larges cale and comprehensive preventive and therapeutic intervention measures for addressing the problem (AU)

Association of severe malaria with ABO-blood group types in an endemic zone of Colombia / Asociación de malaria severa con tipo de grupo sanguíneo ABO en una zona endémica de Colombia

Introduction: malaria is considered one of the most important tropical illnesses in public health causing millions of infections and deaths each year. Many studies have tried to establish an association between the severe form of the disease and the ABO-blood group type. In Colombia, a country with large endemic zones for malaria there are not enough studies or statistic data about this possible association. Methods: a retrospective case-control study of patients with severe and uncomplicated malaria in the endemic zone of Apartadó, Colombia, was performed between January 2000 and June 2006. Only the clinical records with blood group ABO and Rh classification were included. Results: a total sample of 92 patients was obtained: 49 with severe malaria and 43 with uncomplicated malaria. From the total sample, 68.5% were women and the median age of 21.5 years (min 1-max 80). Of the patients with diagnosis of severe malaria, 59.2% were women. The more frequent parasite species was Plasmodium falciparum. Severe malaria was more frequent among patients classified with blood group O (65.3%) and positive Rh (93.9%), but this association was not statistically significant. Conclusion: even though severe malaria was more frequent among patients classified with blood group O and positive Rh, an association between blood group and severe malaria could not be established. The controversial association of these variables previously found in other populations could be probably explained by the demographic distribution and characteristics of those.

Introducción: la malaria es considerada una de las más importantes enfermedades tropicales en salud pública, causando millones de infecciones y muertes cada año. Muchos estudios han tratado de establecer una asociación entre la forma grave de la enfermedad y la clasificación sanguínea ABO. En Colombia, un país con grandes zonas endémicas de malaria, no existen suficientes estudios y datos estadísticos acerca de esta posible asociación. Métodos: se realizó un estudio de casos y controles de pacientes con malaria severa y no complicada en la zona endémica de Apartadó, Colombia y ejecutado entre enero de 2000 y junio de 2006. Sólo las historias clínicas con información acerca de la clasificación sanguínea ABO o Rh fueron incluidas. Resultados: la muestra total fue de 92 pacientes, 49 con malaria grave y 43 con malaria no complicada. De la muestra total, 68,5% eran mujeres y la edad media de 21,5 años (mínimo1-máximo 80). De los pacientes con diagnóstico de malaria grave, 59,2 % eran mujeres. El parásito más frecuente fue la especie de P. falciparum. La malaria grave fue mas frecuente entre los pacientes clasificados con grupo sanguíneo O (65,3%) y Rh positivo (93,9%), pero esta asociación no fue estadísticamente significativa. Conclusión: aunque la malaria severa fue mas frecuente en pacientes con grupo sanguíneo O y Rh positivo, una asociación entre la severidad de la malaria y la clasificación sanguínea no pudo ser establecida. La controvertida asociación entre estas variables previamente encontrada en otras poblaciones, probablemente puede ser explicada por la distribución y características demográficas de dichas poblaciones.

Evaluación del resultado de la terapia con puva en pacientes con estadios tempranos de micosis fungoides: seguimiento a 8 años / Eight years follow up of patients with early stage cutaneous T cell Lymphoma in treatment with psoralen plus UVA

Antecedentes: en la actualidad existen muy pocos datos en la literatura acerca de la evolución a largo plazo de los pacientes con micosis fungoides (MF) en tratamiento con PUVA. (fotoquimioterapia con radiación ultravioleta tipo A). Objetivos: Conocer las características epidemiológicas y clínicas de los pacientes con diagnóstico de MF en tratamiento con PUVA en el servicio de dermatología del CES-Sabaneta, y determinar qué impacto tiene la terapia de mantenimiento en la prevención de recaídas y en la sobrevida. Métodos: se realizó un estudio descriptivo y retrospectivo, con los pacientes con diagnóstico de MF desde abril de 1997 hasta junio de 2005.

Background: PUVA is considered first line therapy in early stages of mycosis fungoides. There are few reports in the literature about the long term follow up of these patients. Objective: to describe the epidemiology and clinical characteristics of patients with early stages of mycosis fungoides in PUVA therapy, in the Dermatologic Center CES-Sabaneta. We wanted to know the relationship between PUVA therapy and patient’s evolution, response to treatment, survival rates, relapse and adverse effects. Methods: a single center, retrospective, descriptive study was done. We included all patients with confirmed diagnosis of mycosis fungoides, who assisted PUVA therapy between April of 1997 and June of 2005.

Consumo de anfetaminas para mejorar rendimiento académico en estudiantes de la Universidad de Manizales, 2008 / Use of amphetamines to improve the academic performance in students of the University of Manizales, 2008

Objetivo: Identificar la frecuencia del uso no medicado de anfetaminas y otras sustancias, para mejorar rendimiento académico, en estudiantes de la Universidad de Manizales (Manizales, Caldas, Colombia). Materiales y métodos: Se realizó un estudio de corte transversal. La población fue de 3616 estudiantes de todas las facultades de la Universidad de Manizales, con una muestra representativa de 309 estudiantes. Se empleó una encuesta anónima, que permitió identificar el consumo de anfetaminas, otras sustancias relacionadas y factores asociados. Resultados: La edad promedio fue de 20,46 años, estrato medio. La muestra más numerosa fue de las facultades de Medicina (17,5 por ciento) y Derecho (16,8 por ciento). 32,8 por ciento informó el consumo de drogas como marihuana (68,9por ciento), popper (26,9por ciento), éxtasis (22,6 por ciento). 14,6b por ciento manifestó consumir anfetaminas para mejorar rendimiento académico, otras sustancias son marihuana y cocaína, consumos asociados a época de parciales; este consumo resultó ser dependiente de la Facultad (Medicina 42,3 por ciento, Economía 16,7 por ciento y semestre cursado (9° semestre 44 por ciento, 5° semestre 24,1 ior ciento); 71 por ciento que consumió metilfenidato manifestó obtener resultados favorables. Como factores asociados a este consumo se encontró el consumo de alcohol y el consumo de drogas en general. Conclusiones: El consumo de anfetaminas en esta universidad es alarmante, particularmente en las facultades de Medicina (42,3 por ciento) y Economía 16,7 por ciento. Para prevenir el abuso y consumo de sustancias para mejorar rendimiento académico, es necesaria una intervención integral, que contemple tanto aspectos personales del estudiante como de la institución.

Prevalencia y comportamiento de los factores de riesgo del síndrome metabólico según los diferentes intervalos de edad, en una población femenina del área de influencia de la Clínica Las Américas, en Medellín - Colombia / Prevalence and behaviour of risk factors in metabolic syndrome according to different age intervals, in a female cohort of the area of influence of the Clínica de las Américas in Medellín, Colombia

Antecedentes: el síndrome metabólico es una entidad de alto impacto epidemiológico, compuesto por elementos que tienen como sustrato común la resistencia a la insulina y son factores de riesgo para desarrollar enfermedad cardiovascular y diabetes.Objetivos: determinar la prevalencia del síndrome metabólico y describir el comportamiento de sus componentes en las diferentes etapas de la vida femenina, según la clasificación del National Cholesterol Education Program and Adult Treatment Panel III (ATP III) y la definición del consenso mundial de la International Diabetes Federation (IDF) 2005.Diseño y Métodos: estudio descriptivo de corte transversal, en el cual se incluyeron 271 voluntarias divididas en tres grupos etáreos (menores de 40, entre 40 y 64 y mayores de 65 años) quienes tuvieron evaluación clínica y por laboratorio con el fin de determinar la prevalencia de los factores de riesgo que constituyen el síndrome metabólico según las clasificaciones descritas.Resultados: la prevalencia del síndrome metabólico fue mayor al aplicar la definición de la IDF y significativamente superior en quienes superaban los 65 años para las dos clasificaciones, en comparación con las menores de 40 años. En las mujeres con diagnóstico de síndrome metabólico, el número de factores de riesgo incrementó con la edad al aplicar los criterios del ATP III.Conclusiones: el síndrome metabólico en la mujer, es una manifestación multifactorial en la cual la edad y el estado menopáusico son importantes factores que predisponen a padecerlo. Los resultados son aplicables a poblaciones de estrato socioeconómico medio y medio-alto de la ciudad y se asemejan a hallazgos publicados por otros autores.

Application of microsatellite genotyping to the study of a restricted Leishmania infantum focus: different genotype compositions in isolates from dogs and sand flies.

Leishmania infantum polymorphism was studied by DNA microsatellite analysis of 110 L. infantum stocks (94 from dogs, 15 from sand flies, and 1 from a human visceral case) from a rural leishmaniasis-endemic area (Priorat) in northeastern Spain. Three microsatellites of the eight present in three fragments (internal transcribed spacer, Lm4, and Lm2) of L. infantum nuclear DNA are polymorphic inside the focus, resulting in 17 genotypes. Isolates from dogs and sand flies had different allelic compositions and shared only four genotypes. Microsatellite analysis is useful for L. infantum genotyping and epidemiologic tracking. Its application with strains from dogs and vectors in an area endemic for leishmaniasis shows the heterogeneous distribution of L. infantum in hosts living in sympatric conditions.